COVID-19 Vaccination Waiting List

Town of Palm Beach COVID-19 Vaccination Waiting List

Please fill out the following information to be placed on a wait list for the potential to receive a COVID-19 vaccination from the Town of Palm Beach's Closed POD if and when more supply is received in the future. The wait list is limited to Town of Palm Beach residents only. Proof of residency will be required. Please do not make more than one submission per person.
Are you a Town of Palm Beach Resident? Please select Yes or No. *
Are you age 65 or older as of today? Please select Yes or No. *
Name *

First Name Last Name
Address *

Street Address

Apartment/Condo/Unit

City State / Province

Postal / Zip Code
Phone Number (Mobile Preferred) *
Email Address (format example@example.com) *
Birth Date *

Month Day Year
Please verify that you are human *
Submission Counter
Should be Empty:

Town of Palm Beach COVID-19 Vaccination Waiting List